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See a sample rate comparisonCPT 97161 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Pt Eval Low Complex 20 Min, Physical Therapy Evaluation Low Complexity Requiring These Components A History With No Personal Factors And Or Comorbidities That Impact The Plan Of Care An Examination Of Body System S Using Standardized Tests And Measures Addressing 1 2 Elements From Any Of The Following Body Structures And Functions Activity Limitations And Or Participation Restrictions A Clinical Presentation With Stable And Or Uncomplicated Characteristics And Clinical Decision Making Of Low Complexity Using Standardized Patient Assessment Instrument And Or Measurable Assessment Of Functional Outcome Typically 20 Minutes Are Spent Face To Face With The Patient And Or Family
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Physical Medicine and Rehabilitation Evaluations |
| Common Place of Service | 11 - Office |
| Common Modifiers | GP - Services delivered under an outpatient physical therapy plan of care 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | $97.87 national non-facility rate (2026) · View Medicare rates for 97161 |
| Medicaid Fee Schedule | $79.56 median of the 7 states in the free preview · View Medicaid rates for 97161 |
National average reimbursement for CPT 97161 by major payers:
$99.32
$89.92
$91.01
$108.78
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CPT 97161
5 of 25 sample ratesHigher to lower in this preview
Gabriella Preston
Sunnyview Hospital And Rehabilitation Center
$173.67Published rateShishkin Physical Therapy Rehab PC
$88.00Published rateEllie Phillips-Burdge, LLC
Ellie Phillipsburdge LLC
$84.00Published rateTonirose Mendiola
$75.93Published rateStewart Schwartz
$51.83Published rate
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See a sample payer proposalCPT 97161 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97161 code is part of the Medicine Services and Procedures services used for Physical Medicine and Rehabilitation Evaluations. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 97161 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 97158-CPT | Low | Adaptive Behavior Therapy, Fifteen Minutes Of Adaptive Behavior Treatment With A Physician Or Other Health Care Professional In A Group Setting. This Therapy Identifies Causes Of Stress Triggers To Anxiety And Patterns Of Response And Helps The Individual Develop New Behaviors. |
| 97161-CPT | Low | Pt Eval Low Complex 20 Min, Physical Therapy Evaluation Low Complexity Requiring These Components A History With No Personal Factors And Or Comorbidities That Impact The Plan Of Care An Examination Of Body System S Using Standardized Tests And Measures Addressing 1 2 Elements From Any Of The Following Body Structures And Functions Activity Limitations And Or Participation Restrictions A Clinical Presentation With Stable And Or Uncomplicated Characteristics And Clinical Decision Making Of Low Complexity Using Standardized Patient Assessment Instrument And Or Measurable Assessment Of Functional Outcome Typically 20 Minutes Are Spent Face To Face With The Patient And Or Family |
| 97162-CPT | Low | Pt Eval Mod Complex 30 Min, Physical Therapy Evaluation Moderate Complexity Requiring These Components A History Of Present Problem With 1 2 Personal Factors And Or Comorbidities That Impact The Plan Of Care An Examination Of Body Systems Using Standardized Tests And Measures In Addressing A Total Of 3 Or More Elements From Any Of The Following Body Structures And Functions Activity Limitations And Or Participation Restrictions An Evolving Clinical Presentation With Changing Characteristics And Clinical Decision Making Of Moderate Complexity Using Standardized Patient Assessment Instrument And Or Measurable Assessment Of Functional Outcome Typically 30 Minutes Are Spent Face To Face With The Patient And Or Family |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97161. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97161 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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